Health insurance and pre existing conditions explained
When you apply for private health insurance, the insurer will ask about your health and lifestyle. That’s when you’ll need to let them know if you have a pre-existing medical condition. In this guide, we clarify what health insurance for pre-existing conditions is. We explain what it means if you have a pre-existing condition and how underwriting works.
What is a pre-existing medical condition?
A pre-existing condition is any medical problem you've had before applying for private health cover. These can be:
- physical health conditions
- mental health issues
- long-term conditions
- one-off medical events
Conditions like high blood pressure, asthma and diabetes can all be pre-existing conditions. Also, depression and anxiety, as well as broken bones, migraine, backache, hip and knee pain.
Even if you're waiting for test results or haven't yet seen a medical professional, it's still considered a pre-existing condition. You need to let your insurer know if you've had any symptoms, medication, tests or treatment for any illness or injury in the past. If you're not completely open and honest, then you may not be covered when it comes to getting treatment.
Examples of pre-existing conditions
| Physical conditions | Long-term conditions | One-off medical events |
|---|---|---|
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How do insurers assess pre‑existing conditions?
When you apply for health insurance, you'll be taken through a series of questions. This process is called medical underwriting. It's the insurance company's risk assessment to establish what terms they can offer. The application for health insurance will include questions about your age, occupation and where you live. It may also include questions about your health.
You're likely to be offered a choice of Moratorium Underwriting or Full Medical Underwriting. And there are other types of underwriting if you're switching insurance companies, or you belong to a company scheme. Each one assesses pre-existing conditions differently.
Moratorium Underwriting (Mori)
With Moratorium Underwriting, you don't need to tell the insurance company about your full medical history when you take out cover. Instead, the insurer assesses claims when they're made, excluding any conditions you had symptoms of, received treatment or advice for, or were aware of in the five years before your cover started.
For a pre-existing condition to become eligible for cover, you must have a continuous two-year period without receiving treatment, advice, or medication for that condition after your cover starts.
The benefit of Moratorium Underwriting is it's easy to apply and you can get cover quickly. But a claim may take longer, as the insurance company will need to go through your medical history.
Full medical underwriting (FMU)
With Full Medical Underwriting, you'll be asked about your medical history when you apply for health insurance. The insurer can then decide if they want to insure you or not for a pre-existing condition.
As part of the assessment, you may be asked to:
- complete a full medical questionnaire
- consent to the insurance company looking at your medical records
If you have a complicated or unusual medical history, this type of underwriting may take some time to complete. But if you need to make a claim you'll already know whether the condition you're claiming for is covered. And this can speed up your claim.
Continued Personal Medical Exclusions (CPME) and Medical History Disregard (MHD)
If you're switching from another provider, you may be eligible for Continued Personal Medical Exclusions (CPME). This means any medical exclusions on your existing policy are typically carried over to your new health plan. However, you'll be asked to complete a brief health declaration, and based on your responses, insurer may apply additional exclusions.
With Medical History Disregard (MHD) you don't need to declare any pre-existing conditions. The policy covers any condition, even if you already have that condition. These types of plans are only usually available through your employer.
Learn more: The different types of medical underwriting explained
What's usually covered vs not covered with health insurance?
When it comes to health insurance, you'll find that most insurers only offer cover for acute conditions. These are conditions that develop suddenly and are likely to get better with treatment.
Chronic conditions won't usually be covered. These are long-term ongoing conditions that can be managed day-to-day. Such as diabetes or high blood pressure.
Learn more: What is private health insurance?
Acute vs chronic conditions
An acute condition can be anything from a broken finger to a stroke. Insurers tend to focus on the outcome rather than the severity of the condition. So, if the condition can be treated and potentially cured, you can usually have private treatment.
When symptoms develop into a chronic condition, you get your consultations and tests done privately. But once you're diagnosed with a chronic condition, cover for that condition will end.
Chronic conditions tend to be very well managed by the NHS. But because they need ongoing treatment, they won't be covered by your insurance. You can still use the NHS even if you have private medical care. This means you can continue treatment for a chronic condition with the NHS.
Common general exclusions
Although exclusions vary from one provider to another, most private health insurance excludes:
- Emergency treatment
- Cosmetic procedures
- Routine pregnancy and childbirth and infertility treatment
- Treatment for alcohol and drug abuse
- Any treatment that takes place outside the UK.
When can a pre‑existing condition become covered again?
With Full Medical Underwriting, a pre-existing condition will either be accepted or excluded when you set up your policy. So, once it's excluded, it's unlikely that you'll be able to get cover for it again. In some rare cases, where multiple or complex conditions are disclosed, insurer may not be able to offer cover for those conditions.
With Moratorium Underwriting, it is possible that a pre-existing condition can be covered in the future. This is because of the two year symptom-free period. This allows pre-existing conditions to 'regain' cover if you've been free from treatment, medication or advice for two years.
Let's look at an example: Martin had back pain that was treated with physiotherapy four years ago. As it was less than five years ago, any claim for back pain within two years of starting the plan will be excluded from cover. Three years later, Martin experiences the back pain again. But because he's been free from symptoms and treatment for three years, he can access private physiotherapy through his insurance.
Underwriting terms can be tricky to understand, so please read the policy information carefully. If in doubt, speak to a specialist health insurance adviser.
Does a pre existing condition change your premium?
Having a pre-existing condition doesn't automatically mean your health insurance will cost more than for someone without one. However, it's important to understand exactly what your policy covers, as treatment for pre-existing conditions is typically excluded from cover.
Premiums are mainly based on age, medical inflation, and claims history, not just the presence of a pre-existing condition. Treatments for pre-existing conditions are usually not covered, so knowing what you're paying for is essential.
Important considerations during your application
Be completely honest about your health history. You must provide full and accurate information about your medical history when applying. Failing to disclose your pre-existing condition or providing incomplete information can have serious consequences, including:
- Claims being rejected
- Changes to your policy terms
- Cancellation of your cover
- Being required to repay treatment costs already paid by the insurer
Understanding your exclusions. Your pre-existing condition will be listed as a personal medical exclusion on your membership certificate, along with any related conditions or complications. This creates a permanent record of what cannot be claimed under your policy.
Exclusions are typically permanent. While some personal medical exclusions can be reviewed after 12 months of coverage, chronic conditions are not eligible for review or removal.
Why choose Vitality health insurance?
Thinking about taking out a health insurance policy or want to learn more about what Vitality offers?
Here's why 2 million people choose Vitality:
Comprehensive Core Cover
- Primary Care benefits including video consultations with a Vitality GP and access to our 24/7 Health Advice Line.
- Mental Health support, with up to 8 Talking Therapy sessions per year—including CBT and counselling.
- Private physiotherapy, with up to 6 sessions annually through our network of providers.
- In-patient and day-patient treatment with full cover for hospital fees, consultant fees, and diagnostic scans when admitted.
- Advanced Cancer Cover with full support for treatment, including drug therapies and personalised care.
- Vitality Menopause Support, delivered in partnership with Peppy.
- Plus, extras like NHS Hospital Cash Benefit, Childbirth Cash Benefit, and Home Nursing after hospital stays.
The Vitality Programme
We go beyond traditional health insurance by supporting you to live a healthier life - and rewarding you for it.
- Earn Vitality points by taking part in healthy activities such as exercising, completing health assessments, or attending check-ups.
- Your points contribute to your Vitality status—Bronze, Silver, Gold or Platinum.
- The higher your status, the more you could save on your premium at renewal.
- You'll also unlock access to a wide range of discounts and rewards from partners like Apple Watch, Amazon Gift Card, Deliveroo, PureGym and many more.
Smart Digital Tools
Manage your health journey with ease through the Care Hub, available via Member Zone or the Vitality app:
- Book GP appointments
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- Self-refer for physiotherapy or Talking Therapies
- Access personalised support—all in one place
Ready to Get a Quote?
Getting a personalised health insurance online quote with Vitality is quick, simple, and hassle-free.
Just answer a few basic questions—like your age, location, and preferred level of cover—and we'll show you how much your plan could cost.
Need help with getting a quote? Our qualified experts are here to help.
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Key takeaways
- A pre-existing condition is any medical problem you've had before applying for private health cover. Included are conditions like high blood pressure, asthma, back pain and anxiety. As well as broken bones, migraine, hip and knee pain.
- Even if you're waiting for test results or haven't yet seen a medical professional, it's still considered a pre-existing condition.
- Underwriting is the insurers way of deciding whether they can insure you. The two main types of underwriting are Moratorium Underwriting and Full Medical Underwriting. Each one assesses pre-existing conditions differently.
- Most insurers only offer cover for acute conditions. These are conditions that develop suddenly and are likely to get better with treatment. Chronic conditions won't usually be covered. These are long-term ongoing conditions that can be managed day-to-day. Such as diabetes or high blood pressure.
- Our underwriting principles may be similar to other providers. But we also focus on rewarding a positive lifestyle.
